In re Linda B. , 2017 IL 119392 ( 2018 )

Digitally signed by
Reporter of Decisions
Illinois Official Reports Reason: I attest to the
accuracy and integrity
of this document
Date: 2018.03.02
Supreme Court 15:26:37 -06'00'
In re Linda B., 2017 IL 119392
Caption in Supreme In re LINDA B. (The People of the State of Illinois, Appellee, v. Linda
Court: B., Appellant).
Docket No. 119392
Filed September 21, 2017
Rehearing denied November 20, 2017
Decision Under Appeal from the Appellate Court for the First District; heard in that
Review court on appeal from the Circuit Court of Cook County, the Hon.
David Skryd, Judge, presiding.
Judgment Affirmed.
Counsel on Veronique Baker, Ann Krasuski, and Laurel Spahn, of Legal
Appeal Advocacy Service of the Guardianship & Advocacy Commission, of
Hines, for appellant.
Lisa Madigan, Attorney General, of Springfield, and Kimberly M.
Foxx, State’s Attorney, of Chicago (Alan J. Spellberg and Matthew
Connors, Assistant State’s Attorneys, of counsel), for the People.
Cheryl R. Jansen, of Equip for Equality, of Springfield, amicus curiae.
Justices CHIEF JUSTICE KARMEIER delivered the judgment of the court,
with opinion.
Justices Freeman, Thomas, Kilbride, Garman, Burke, and Theis
concurred in the judgment and opinion.
OPINION
¶1 The overarching issue presented in this appeal is whether a timely petition was filed,
seeking immediate, involuntary admission of respondent for inpatient psychiatric treatment in
a mental health facility pursuant to article VI of the Mental Health and Developmental
Disabilities Code (Mental Health Code) (405 ILCS 5/3-600 et seq. (West 2012) (Emergency
Admission by Certification)). In order to reach that issue, we must find that an exception to the
mootness doctrine applies, as the 90-day period of hospitalization ordered by the Cook County
circuit court has expired. The appellate court so found and affirmed the judgment of the circuit
court. 2015 IL App (1st) 132134. On this record, and with some qualification with respect to
the appellate court’s analysis, we affirm the judgment of the appellate court.
¶2 BACKGROUND
¶3 Proceedings in this case were initiated on May 9, 2013, when Connie Shay-Hadley, the
mental health facility director at Mount Sinai Hospital (Mt. Sinai), filed a petition alleging that
respondent, Linda B., was a person subject to involuntary admission to a treatment facility.
The petition sought emergency inpatient admission by certificate, pursuant to section 3-600 of
the Mental Health Code (405 ILCS 5/3-600 (West 2012)), stating that respondent was admitted
to the “Mental Health Facility/Psychiatric Unit” on April 22, 2013.
¶4 The petition was supported by certificates submitted by Dr. Medela Gartel, who examined
respondent on May 9, 2013, and Colleen Kurtz, a licensed clinical social worker who
examined respondent later that same day. Both checked form boxes stating that respondent
was mentally ill and required “immediate hospitalization” for the prevention of harm to
respondent or others. Both stated that respondent was in need of treatment to prevent
deterioration of her condition and that she could not understand the nature of her illness or the
need for treatment. Gartel added, via handwritten notation, that respondent had exhibited
“multiple psychiatric symptoms including paranoid delusions,” she had been violent with
medical staff, and she had been wandering and defecating in the hall. Kurtz corroborated that
observation as well as Gartel’s suggestion that respondent suffered from paranoid delusions.
Kurtz added that respondent was refusing both medical and psychiatric medications.
¶5 On June 11, 2013, the trial court held a hearing addressing the matter of involuntary
admission.1 At that hearing, Dr. Elizabeth Mirkin, a board-certified psychiatrist, testified that
1
Hearing on the May 9 petition was originally set for May 14, 2013, five days from the date upon
which the petition was filed, which would seem to comport with the temporal requirement for a hearing
set forth in section 3-611 of the Mental Health Code. See 405 ILCS 5/3-611 (West 2012) (“the court
shall set a hearing to be held within 5 days *** after receipt of the petition”). Multiple “case
management orders” were entered thereafter continuing the date for the hearing. Although the appellate
-2-
respondent’s hospitalization at Mt. Sinai began on April 22, 2013, when she was admitted to a
“medical floor,” where she was also “treated psychiatrically.” With respect to the
circumstances prompting respondent’s admission, Mirkin volunteered:
“She actually was board—agitated and very angry behaviors before she was admitted
in medical floor because she was tachycardia and found to be severely anemic.[2] She
was admitted to the medical floor. She was followed by a psychiatrist throughout her
stay on the medical floor.”
Mirkin also stated that respondent had sitters “throughout her stay on the medical floor.”
¶6 Mirkin testified that she first saw respondent on the medical floor on May 25, 2013. She
had previously spoken to other staff members and had reviewed “other people psychiatry
progress notes, nursing notes, doctors notes.” Mirkin stated that respondent was hospitalized
for “both” psychiatric and medical treatment. Mirkin noted that this was not respondent’s first
hospitalization. She had been admitted to Mt. Sinai’s psychiatric unit in January 2013 “with
similar presentation.” According to Mirkin, respondent was admitted again in April. There had
been “multiple prior hospitalizations.” Mirkin diagnosed respondent as suffering from
schizophrenic disorder, stating that respondent had suffered from that malady for years.
¶7 Mirkin described, in detail, the symptoms respondent had exhibited: “[S]he was very
delusional, very aggressive, agitated and threatening, labile and did not sleep, threatened staff,
did not take medications for psychiatric and medical reasons.” Mirkin said that respondent was
“much less symptomatic” at the time of the hearing because, pursuant to court order entered
May 14, 2013,3 respondent was taking prescribed medications. Though Mirkin acknowledged
that respondent was “less symptomatic,” she maintained that respondent was still delusional,
easily agitated, aggressive, and subject to rapid mood swings. Mirkin observed that respondent
had a history of noncompliance in taking medications, particularly whenever she was
discharged from the hospital. Mirkin rendered her opinion, based upon a reasonable degree of
psychiatric certainty, that respondent was unable, because of her mental illness, to provide for
her basic physical needs without assistance and thus should be treated on an inpatient basis.
Mirkin recommended that respondent be treated at Park Shore Nursing Home.
court makes no mention of it, an amended petition for involuntary admission was filed on June 11, the
day of the hearing. That petition appears to differ from the original petition in that (1) it was no longer
alleged, as a basis for involuntary admission, that respondent “could be reasonably expected to engage
in conduct” that might physically harm herself or others and (2) a report before disposition was
attached—with supporting documentation from Kurtz and an “attending psychiatrist”—addressing an
alternative treatment setting. The deleted allegation may have been in furtherance of a recommendation
that respondent, who was homeless, be sent to a nursing home. We note, in passing, that Kurtz, in her
statement, referred to having seen respondent “on psychiatric unit during previous admission.” Dates
are not provided, so it is not clear when that “previous admission” might have been. In any event, the
parties do not accord the filing of the amended petition any significance, and respondent does not
complain that the hearing in this case was untimely. Therefore, we will not further address that
procedural aspect of the case.
2
Dr. Mirkin testified that she graduated from medical school in St. Petersburg, Russia. At times, the
syntax of her testimony corroborates the inference that English is not her first language. Grammatical
lapses will not be noted hereafter.
3
The record indicates that medication was ordered in case No. 2013 COMH 1388.
-3-
¶8 In her cross-examination, counsel for respondent asked: “Is [respondent] recommended for
nursing home placement because of mental health reasons or because of medical reasons?”
Mirkin responded:
“Because of combination of mental health reasons and medical reasons. In her case,
her mental health conditions prevents her from taking care of her medical condition.
When she has exacerbation of her mental illness, then she doesn’t take care of herself,
including her many medical conditions.”
Inquiries by counsel regarding Park Shore Nursing Home revealed that Mirkin had very
limited knowledge thereof. However, when asked whether Park Shore Nursing Home provided
“behavioral mental health care or whether they primarily provide[d] medical care to elderly
senior citizens,” Mirkin replied: “Because [respondent’s] diagnosis is schizoaffective disorder,
she could not be admitted to the nursing home, which does not provide care for behavioral
health.”
¶9 Upon further examination of Mirkin by respondent’s counsel, the following colloquy
ensued:
“Q. Doctor, according to the chart, you’ve indicated as of approximately May 28th,
the respondent was ready for discharge from Mt. Sinai, correct?
A. I had a note there. I saw her on the unit and I didn’t say that she is ready for
discharge. I said that she does not need inpatient level of psychiatric care.
I said this is her baseline, but I never indicated that she could be discharged home.
There was a process going on while she was on medical floor for her to be admitted to
the nursing home; and by my note, I stated that she does not need to be transferred to
inpatient psych unit.
Q. So all this time, from April 22nd to the present day, [respondent] has been on a
medical unit and not a psychiatric hospital [sic] at the hospital?
A. She was cleared medically only as of last Saturday. *** At that time we found
out we’re going with a nursing home placement. There’s no point of her to be
transferred to six—the transfer to Six East mainly because on the medical floor, she’s
been on one-to-one supervision; and the nursing home will not accept anybody to the
nursing home unless their 24 hours of supervision and psychiatric unit is more
appropriate for her.
She hasn’t been on supervision here unless she was admitted there last night. She
hasn’t been put on one-to-one supervision.
While on medical floor, she needed one-to-one sitter. *** Constantly, she needed to
have supervision all of the time.
Q. That’s one of the conditions for Park Shore to accept [respondent], that she goes
24 hours without having a sitter?
A. Yes. Any nursing home inpatient, yes.”
¶ 10 Following cross-examination and after the State rested, respondent’s counsel moved to
dismiss the petition for involuntary admission “based upon the petition having been filed well
beyond the 24 hours after [respondent’s] admission.” Counsel argued that the petition was
untimely filed where respondent was admitted to the medical floor of Mt. Sinai on April 22,
2013, but was also being treated psychiatrically from that date.
-4-
¶ 11 Over counsel’s objection, the court allowed the State to reopen its case in order to adduce
evidence pertinent to respondent’s motion. Speaking to the procedures the hospital generally
employs with respect to involuntary admission, Mirkin explained:
“We have—when patient is admitted to medical floor, if medical team feels that
psychiatric treatment needed or psychiatrist needs to be seen, we feel and I feel and
consults every day, four or five patients.
We don’t submit any petitions for any other patients unless we start believing that
patients need, either psychiatric admission or patient needs treatment against their will.
Patients are on typical medical floor without—even now at this moment, I see like
every day, I see four or five patients on medical floors. We do not do petitions unless
we think the patient needs to go to court because the patient is noncompliant with
treatment.”
Counsel for the State asked: “Was the decision made when it was determined that she needed
inpatient psychiatric treatment?” Mirkin responded:
“At that time she was still on medical floor. I was not in service at that time, but I
reviewed the chart. I thought it was appropriate when the doctor went to court on May
14 because it was considered that she needed psychiatric treatment and she was not
taking medications.”
Counsel for the State then asked: “So initially, the primary purpose for [respondent’s]
hospitalization was for medical treatment?” Mirkin responded: “For both, but she was on
medical floor, so we never start petitions while patient is on medical floor, unless we think that
she needed more psych, more structured environment. It is not at all appropriate. We never do
this.”
¶ 12 Following Mirkin’s testimony, the circuit court denied respondent’s motion to dismiss the
petition for involuntary admission. Respondent then rested without testifying or presenting
evidence.
¶ 13 After closing argument, the circuit court granted the petition for involuntary admission. In
its written order, the court found respondent subject to involuntary admission on an inpatient
basis because (1) respondent’s mental illness rendered her unable to provide for her basic
physical needs and to guard herself from serious harm and (2) respondent’s mental illness
resulted in (a) her refusal of necessary treatment, (b) her inability to understand the need for
such treatment, and (c) a reasonable expectation that, if respondent was not treated, she would
suffer further mental or emotional deterioration. The written order also provided that
respondent be treated at Park Shore Nursing Home, based on Dr. Mirkin’s recommendation,
for a period of hospitalization not to exceed 90 days.
¶ 14 In respondent’s ensuing appeal, the appellate court first noted that respondent’s 90-day
period of hospitalization had expired, rendering the appeal moot, as the appellate court could
no longer grant respondent effectual relief. 2015 IL App (1st) 132134, ¶ 11. However, the
appellate court considered and applied the public interest exception to the mootness doctrine to
address the merits of the issues raised by respondent. Id. ¶ 13.
¶ 15 On the merits, the appellate court appears to have resolved this case on the bases of two
premises: (1) respondent’s “physical” admission to the hospital was not synonymous with
“legal” admission under article VI of the Mental Health Code (2015 IL App (1st) 132134,
¶ 19), and (2) the medical floor of the hospital, arguably, was not a “mental health facility”
-5-
within the meaning of the statute, irrespective of whether psychiatric treatment was rendered
there (id. ¶ 23). Thus, the appellate court affirmed the judgment of the circuit court, concluding
that the petition for involuntary admission was timely filed.
¶ 16 ANALYSIS
¶ 17 Initially, we note that this appeal is moot because respondent’s underlying 90-day
admission period has expired. See In re Andrew B., 237 Ill. 2d 340, 346 (2010). Consequently,
we must determine whether an exception to the mootness doctrine applies. Id. One exception
to the mootness doctrine allows a court to resolve an otherwise moot issue if the issue involves
a matter of substantial public interest. Bettis v. Marsaglia, 2014 IL 117050, ¶ 9. Respondent
argues that exception applies to questions posed in this appeal.
¶ 18 I. Public Interest Exception
¶ 19 The public interest exception permits review of an otherwise moot appeal when three
requirements are met: (1) the question presented must be public rather than case-specific in
nature; (2) an authoritative determination is needed to guide public officers in future cases; and
(3) there is a likelihood the issue will recur. People v. Holt, 2014 IL 116989, ¶ 47; Andrew B.,
237 Ill. 2d at 347. This exception must be construed narrowly and established by a clear
showing of each criterion. Andrew B., 237 Ill. 2d at 347.
¶ 20 We believe the requisites for application of the public interest exception are satisfied in this
case. “ ‘[T]he procedures which must be followed *** before a court may authorize
involuntary treatment to recipients of mental health services are matters of a public nature and
of substantial public concern.’ ” In re Lance H., 2014 IL 114899, ¶ 14 (quoting In re Mary Ann
P., 202 Ill. 2d 393, 402 (2002)). Obviously, as this court acknowledged in Lance H., the same
can be said of the procedures for involuntary commitment. Id. Moreover, we find that the
circumstances in this case meet the second criterion for application of the exception because
there is apparently uncertainty as to the type of facilities, or portions thereof, that meet the
statutory definition of a “mental health facility” (see 2015 IL App (1st) 132134, ¶ 23 (the
appellate court in this case assumed, “arguendo, that respondent was in a mental health
facility” while citing appellate authority that clearly suggests otherwise)) and, relatedly,
whether the type of treatment administered in a facility may, in itself, qualify it as a “mental
health facility.” Even more to the point, this case presents the question of whether
simultaneous, hybrid treatment, for both psychiatric and medical conditions, either qualifies
(in the first instance) or disqualifies (in the second) the recipient for status as a mental health
patient in a facility, depending upon which condition predominates. Finally, the third criterion
for application of the exception is met because, as was the case in Lance H., “respondent’s own
history demonstrates how this question might recur.” Lance H., 2014 IL 114899, ¶ 14. Dr.
Mirkin testified that respondent has a history of noncompliance in taking medications,
particularly whenever she was discharged from the hospital, and she has had “multiple prior
hospitalizations.” As was the case in this instance—and is likely the case in many
others—respondent “presented” at the hospital with interrelated psychiatric and medical
problems, which are necessarily subject to holistic treatment and the origins of which are not
subject to neat temporal or treatment categorization. We see this scenario as one likely to recur
-6-
in the general population.
¶ 21 II. Pertinent Statutes
¶ 22 Section 3-600 of the Mental Health Code authorizes a person 18 years of age or older to
seek involuntary admission, “to a mental health facility,” of an individual 18 years of age or
more, who is “in need of immediate hospitalization.” 405 ILCS 5/3-600 (West 2012). Section
1-114 of the Mental Health Code defines a “mental health facility” as “any licensed private
hospital, institution, or facility or section thereof, and any facility, or section thereof, operated
by the State or a political subdivision thereof for the treatment of persons with mental illness
and includes all hospitals, institutions, clinics, evaluation facilities, and mental health centers
which provide treatment for such persons.”4 405 ILCS 5/1-114 (West 2012).
¶ 23 Section 3-601(a) of the Mental Health Code provides:
“When a person is asserted to be subject to involuntary admission on an inpatient basis
and in such a condition that immediate hospitalization is necessary for the protection of
such person or others from physical harm, any person 18 years of age or older may
present a petition to the facility director of a mental health facility in the county where
the respondent resides or is present. The petition may be prepared by the facility
director of the facility.” 405 ILCS 5/3-601(a) (West 2012).
¶ 24 Section 3-601(b)(1) sets forth the aspects of a respondent’s condition that must be
addressed in the petition. Subsection (b)(1) requires a “detailed statement of the reason for the
assertion that the respondent is subject to involuntary admission on an inpatient basis,
including the signs and symptoms of a mental illness and a description of any acts, threats, or
other behavior or pattern of behavior supporting the assertion and the time and place of their
occurrence.” 405 ILCS 5/3-601(b)(1) (West 2012).
¶ 25 Section 3-602 of the Mental Health Code requires that the petition be “accompanied by a
certificate executed by a physician, qualified examiner, psychiatrist, or clinical psychologist
which states that the respondent is subject to involuntary admission on an inpatient basis and
requires immediate hospitalization.” 405 ILCS 5/3-602 (West 2012). The certificate must
evince an examination of the respondent “not more than 72 hours prior to admission” and must
contain “other factual information relied upon in reaching a diagnosis, and a statement as to
whether the respondent was advised of his rights under Section 3-208.” Id.
¶ 26 Finally, section 3-611, at issue here, provides:
“Within 24 hours, excluding Saturdays, Sundays and holidays, after the respondent’s
admission under this Article, the facility director of the facility shall file 2 copies of the
petition, the first certificate, and proof of service of the petition and statement of rights
upon the respondent with the court in the county in which the facility is located. Upon
completion of the second certificate, the facility director shall promptly file it with the
court. The facility director shall make copies of the certificates available to the
attorneys for the parties upon request. Upon the filing of the petition and first
4
Section 1-113 of the Mental Health Code further defines a “licensed private hospital” as “any
privately owned home, hospital, or institution, or any section thereof which is licensed by the
Department of Public Health and which provides treatment for persons with mental illness.” 405 ILCS
5/1-113 (West 2012).
-7-
certificate, the court shall set a hearing to be held within 5 days, excluding Saturdays,
Sundays and holidays, after receipt of the petition. The court shall direct that notice of
the time and place of the hearing be served upon the respondent, his responsible
relatives, and the persons entitled to receive a copy of the petition pursuant to Section
3-609.” 405 ILCS 5/3-611 (West 2012).
¶ 27 III. Merits
¶ 28 The parties’ arguments concerning the timely filing of the petition focus on two questions.
First, under the circumstances, did the medical floor of Mt. Sinai qualify as a “mental health
facility” as specified in article VI of the Mental Health Code? Second, what constitutes
“admission” for purposes of section 3-611?
¶ 29 A. “Mental Health Facility”
¶ 30 Respondent contends that the appellate court erred when it failed to find that the medical
floor of Mt. Sinai—where she was treated for medical and psychiatric conditions—qualified as
a “mental health facility,” as defined by the Mental Health Code. Respondent observes that the
Mental Health Code broadly defines a “mental health facility” as a private facility, or a section
thereof, or a facility operated by the State or its political subdivisions, that (1) is licensed by the
Department of Public Health and (2) provides treatment for persons with mental illness. See
405 ILCS 5/1-114 (West 2012). She observes that section 1-114 does not require that a mental
health facility have a primary purpose of treating individuals with mental illnesses.
Respondent notes that Mt. Sinai is a licensed general hospital that—as Dr. Mirkin
testified—regularly provides treatment to people with mental illnesses on its medical floors, as
well as in the psychiatric unit. Respondent thus submits, relying upon the psychiatric treatment
she received on a medical floor of the hospital, that the medical floor qualified as a “mental
health facility” as defined by the Mental Health Code.
¶ 31 Respondent takes issue with the appellate court’s reliance upon In re Moore, 301 Ill. App.
3d 759, 766 (1998), arguing that Moore’s narrow construction of the term “mental health
facility”—with respect to hospitals, meaning only “[t]hose sections or units” specifically
dedicated to the treatment of mentally ill patients—is not consistent with the “current reality,”
in which psychiatric services are provided in diverse venues offering both medical and
psychiatric treatment. Respondent notes, for example, that the Illinois Department of Human
Services website directs that those suffering psychiatric emergencies go, or be taken, to the
emergency room at their local hospital.5 Respondent also points to section 3-606 of the Mental
Health Code, which provides that a peace officer “may take a person into custody and transport
him to a mental health facility when the peace officer has reasonable grounds to believe that
the person is subject to involuntary admission on an inpatient basis and in need of immediate
hospitalization to protect such person or others from physical harm.” 405 ILCS 5/3-606 (West
2012). Respondent states that the appellate court “has interpreted this section, and has applied
it to hospital emergency room departments without question though, according to its language,
5
See Mental Health, Ill. Dep’t Hum. Servs., http://www.dhs.state.il.us/page.aspx? item=29735 (last
visited Sept. 8, 2017).
-8-
that section applies specifically to ‘mental health facilit[ies].’ ”6 Further, she asks us to take
judicial notice of 94 involuntary admission petitions, filed over a 22-month period (September
2014 to June 2016), by hospitals that—according to respondent—lack mental health units.7
¶ 32 Respondent concludes: “To construe the Code as applying only to distinct psychiatric units
would result in disparate treatment of individuals with mental illnesses based on the location of
their treatment. *** If this court affirms the appellate court’s decision in In re Linda B., people
could be held in scatter beds[8] on medical floors or in emergency rooms without their consent
and without the legal protections the Code guarantees.” Further, to the extent that the treatment
afforded a patient in a facility may affect the statutory category into which the facility properly
fits, the respondent argues that “respondents [should not] have different rights at different
times dictated by the status of their non-psychiatric health. Individuals without comorbid
medical conditions who could be admitted directly to psychiatric units would be afforded the
Code’s protections of notice, right to counsel, and their day in court, whereas recipients with
serious comorbid conditions would not.” (Emphasis in original.)
¶ 33 As we understand the State’s position—or positions—the State first advocates for a
bright-line rule, relying upon Moore, arguing that the legislature intended that section 3-611
only apply when a patient is admitted to a facility or section thereof specifically designated as,
and operating exclusively as, a “mental health facility.” The State notes that Moore held the
language of the pertinent “statutory provisions recognizes that there may be sections within a
hospital devoted to treatment of mentally ill patients” and concluded “[t]hose sections or units,
and not the entire hospital, are mental health facilities for purposes of the involuntary
admission provisions of the Code.” Moore, 301 Ill. App. 3d at 766.
¶ 34 However, the State also appears to concede that the type of treatment provided to a patient
is relevant in determining the kind of facility in which the patient receives treatment. The State
acknowledges, for example, that “section 5/1-114 implicitly suggests that an emergency room
could be considered a mental health facility as a ‘section’ of a private hospital when used ‘for
the treatment of persons with mental illness.’ ” Notwithstanding, the State submits “[t]hat does
not alter the calculus here, where Dr. Mirkin’s testimony made clear that respondent was
admitted for medical care, and in addition to that care, received psychiatric care.” By that
acknowledgment, the State appears to retreat from espousing a bright-line rule, such as that
6
Respondent cites In re Demir, 322 Ill. App. 3d 989, 990-92 (2001), and In re Joseph P., 406 Ill.
App. 3d 341, 348 (2010), overruled on other grounds by In re Rita P., 2014 IL 115798, ¶¶ 33-34.
7
Public documents, such as those included in the records of other courts and administrative
tribunals, fall within the category of “readily verifiable” facts capable of instant and unquestionable
demonstration of which a court may take judicial notice. Cordrey v. Prisoner Review Board, 2014 IL
117155, ¶ 12; May Department Stores Co. v. Teamsters Union Local No. 743, 64 Ill. 2d 153 (1976).
The fact that the referenced petitions were filed meets the criteria for judicial notice; that the hospitals
in question lacked designated psychiatric facilities turns out to be not so readily verifiable. We decline
to take judicial notice of respondent’s representation in that respect. In the end, it makes no difference
in our analysis or the outcome.
8
“Scatter beds” is a term used in the psychiatry field to refer to psychiatric patient placement in beds
designated for general medical treatment throughout a medical facility, rather than in devoted
psychiatric units. Tami L. Mark et al., Psychiatric Discharges in Community Hospitals With and
Without Psychiatric Units: How Many and for Whom?, 61 Psychiatric Servs. 562 (2010).
-9-
announced in Moore, seemingly advocating for a primary-purpose-of-treatment test and
minimizing the significance of the medical venue where psychiatric treatment is provided.
¶ 35 We note, initially, that it is far from “clear,” based upon the only testimony at the
hearing—Dr. Mirkin’s—that it was respondent’s medical condition alone that brought her to
someone’s attention and resulted in her hospitalization or even that her medical condition was
the primary factor in her hospitalization and treatment. The certificates filed in support of the
petition for involuntary admission do not suggest a contrary inference. Though the State, at the
hearing in this matter, attempted to solicit Mirkin’s acquiescence to the proposition that,
“initially, the primary purpose for [respondent’s] hospitalization was for medical treatment,”
Mirkin responded—contrary to the State’s suggestion otherwise in its brief9—that respondent
was admitted for “both” psychiatric and medical treatment. In fact, Mirkin’s testimony
indicated that it was respondent’s psychiatric condition that led to her acute medical problems:
“In her case, her mental health conditions prevents her from taking care of her medical
condition. When she has exacerbation of her mental illness, then she doesn’t take care of
herself, including her many medical conditions.” Mirkin indicated that respondent exhibited
“agitated and very angry behaviors before she was admitted in [the] medical floor,” and Mirkin
acknowledged that respondent was “followed by a psychiatrist throughout her stay on the
medical floor” and had sitters “throughout her stay on the medical floor.”
¶ 36 It would seem to us that respondent’s psychiatric treatment and supervision on the medical
floor were at least as comprehensive and structured as anything she might have received in the
psychiatric unit, which the State has to concede is a “mental health facility.” We think most
people of ordinary sensibility would agree with the application of abductive reasoning in this
instance and conclude that a facility, or section thereof, capable of providing mental health
services, that does in fact provide the individual mental health services, is a mental health
facility.10 To find otherwise is to exalt a facility’s self-designated nomenclature over its actual
function. We decline to do so.
¶ 37 And there is no reason to do so. The legislature made the definition of “mental health
facility” extremely broad so as to encompass any place that provides for “the treatment of
persons with mental illness.” 405 ILCS 5/1-114 (West 2012). It bears repeating that the Mental
Health Code defines a “mental health facility” as “any licensed private hospital, institution, or
9
The State asserts, in its brief, that “the primary purpose of respondent’s treatment was to address
her deteriorating physical condition” (emphasis added) and “[o]nce her physical health had been
stabilized, respondent was moved to a psychiatric floor, and the petition for involuntary treatment was
filed within 24 hours.” We find no clear support in the record for either proposition. Mirkin declined to
subscribe to the proposition the State now asserts, and her testimony was ambiguous as to whether
respondent was moved to a psychiatric unit and, if so, when; the same can be said of Kurtz’s
documentary reference to having seen respondent on a “psychiatric unit during [a] previous
admission.” Similarly, elsewhere in the State’s brief, the State asserts that “Dr. Mirkin’s testimony was
clear that respondent was admitted to the emergency room at Mount Sinai Hospital, but was then placed
on a medical floor for weeks to address her underlying health concerns.” Although we might assume
that respondent entered the hospital via the emergency room, the term “emergency room” does not
appear in this record, and Dr. Mirkin never testified that respondent was admitted there.
10
With no intent to be flippant, the abductive process is probably never better put than in this
common expression: If it looks like a duck, swims like a duck, and quacks like a duck, then it is
probably a duck.
- 10 -
facility or section thereof, and any facility, or section thereof, operated by the State or a
political subdivision thereof for the treatment of persons with mental illness and includes all
hospitals, institutions, clinics, evaluation facilities, and mental health centers which provide
treatment for such persons.” (Emphases added.) 405 ILCS 5/1-114 (West 2012). The definition
could not be more comprehensive. The legislature sought to include within its ambit the whole
facility or a section thereof and private as well as public facilities. The salient feature of the
definition is that it applies to any facility, or any part of a facility, that provides for “the
treatment of persons [afflicted] with mental illness.” What the facility is called, if and when it
performs some other function, is irrelevant. In those instances in which a facility or section of a
facility provides psychiatric treatment to a person with mental illness—as was the case
here—it qualifies as a “mental health facility” for purposes of the Mental Health Code’s
application.
¶ 38 As this court has repeatedly acknowledged, the administration of involuntary mental health
services involves a “ ‘ “massive curtailment of liberty.” ’ ” In re Robert S., 213 Ill. 2d 30, 46
(2004) (quoting In re Barbara H., 183 Ill. 2d 482, 496 (1998), quoting Vitek v. Jones, 445 U.S.
480, 491 (1980)). As aptly noted in In re Torski C., 395 Ill. App. 3d 1010, 1018 (2009), the
provisions of the Mental Health Code reflect legislative recognition that civil commitment is a
deprivation of personal liberty, and the purpose of its procedures is to provide adequate
safeguards against unreasonable commitment. We believe the legislature enacted a broad
definition of “mental health facility” to further those ends. Appellate decisions inconsistent
with our holding herein are hereby overruled.
¶ 39 In today’s era of integrated, holistic health care, we believe it is unrealistic to think that
medical personnel on a medical floor or in an emergency room—or anyone for that
matter—would not recognize and report someone with psychiatric symptoms as striking as
respondent’s and that psychiatric specialists and structured treatment would not be brought to
bear, irrespective of the medical environment wherein the patient is housed. On the other hand,
one might well understand how a patient could be treated psychiatrically, involuntarily, in
facilities not specifically designated as “mental health facilities” and thus be deprived of the
Mental Health Code’s safeguards. It could well have happened here.
¶ 40 However, we do not know it happened here because the record does not reflect that, prior to
the filing of this petition on May 9, 2013, respondent was an involuntary recipient of
psychiatric services in the hospital. We can readily assume, at some point in time, she resisted
psychiatric treatment, but we do not know for certain when that occurred. Here, we address the
second question posed at the outset of our analysis: What constitutes “admission” for purposes
of section 3-611?
¶ 41 There is no dispute that respondent was physically admitted to the hospital as a patient on
April 22, 2013. The petition for involuntary admission states as much.11 However, nothing in
this record identifies the capacity in which respondent was admitted, i.e., whether she was a
voluntary or involuntary recipient of treatment. At oral argument, counsel for respondent
conceded as much, but she argued that the evidence suggested that respondent was there
involuntarily. Counsel for the State countered that the issue of consent to treatment was not
11
It also states that respondent was admitted to the “Mental Health Facility/Psychiatric Unit” on that
date.
- 11 -
developed at the June 11 hearing and that it was unclear on what date respondent became
noncompliant or treatment became involuntary. Pressed upon this point at oral argument,
counsel for respondent noted that she tried at the hearing to ask Dr. Mirkin by what legal
authority treatment was provided to respondent—consensual or otherwise—but the trial court
sustained the State’s objection that the question was beyond the scope of direct examination.
Counsel explained to this court: “Then there was a decision that that was not needed to be
covered in any kind of case-in-chief, because of trial strategy.” Counsel did not elaborate on,
and we cannot conceive, what the aim of that strategy would have been.
¶ 42 What we are left with is bare-bones evidence of physical admission to the hospital, with
some evidence of communication between hospital personnel and unidentified family
members of respondent. Respondent’s daughter was specifically identified in the petition for
involuntary admission. There was no evidence as to the exact means by which respondent
came to the hospital or how she was admitted there. For all we know, respondent may have
been persuaded to go there voluntarily by family members. Treatment may have been
consensual for a time. As the State suggests, it is unclear what date respondent became
noncompliant or treatment became involuntary.
¶ 43 During oral argument, counsel for respondent was asked whose responsibility it was to
show respondent was previously in the hospital involuntarily. Counsel for respondent would
place that burden on the State, but we believe it is respondent’s burden. It is well established
that, on appeal, the party claiming error has the burden of showing any irregularities that would
justify reversal. Flynn v. Vancil, 41 Ill. 2d 236, 241 (1968). Error is never presumed by a
reviewing court; it must be affirmatively shown by the record. Id. at 241-42. It is the
appellant’s burden to present a sufficiently complete record of the proceedings at trial to
support a claim of error, and any doubts that may arise from the incompleteness of the record
will be resolved against the appellant. Williams v. BNSF Ry. Co., 2015 IL 117444, ¶ 31.
¶ 44 Counsel for respondent was aware of the significance of respondent’s legal status prior to
the filing of the petition; she attempted, unsuccessfully, to cross-examine Mirkin on that very
point during the June 11 hearing. She could have revisited that issue in her portion of the case,
but she informed us during oral argument that she decided not to do so. In order to establish
untimely filing of the May 9 petition, respondent had to establish that her initial period of
hospitalization and psychiatric treatment was involuntary. Whether she could have done so or
not, respondent’s counsel did not make that record.
¶ 45 If the initial treatment was not rendered against respondent’s will, which is entirely
possible—it is reasonable to infer that some change in respondent’s volitional disposition
might have prompted the filing of the petition, after weeks of treatment—then we have a
situation governed by this court’s analysis in Andrew B., as the State contends. In that case, this
court acknowledged what would seem obvious: that a patient’s legal status within a facility
may change while the patient is a resident there.
¶ 46 In Andrew B., respondent voluntarily entered the facility for treatment but later expressed a
desire to leave. A petition for involuntary admission was filed but was later voluntarily
dismissed by the State. The court ordered respondent’s discharge; however, respondent was
not physically released. Instead, the next day a petition was filed for respondent’s emergency
admission by certificate under section 3-600 of the Mental Health Code. That petition, like the
previous one, was then voluntarily dismissed by the State, and the court again ordered
- 12 -
respondent’s discharge. Again, respondent was not released. Yet another petition was filed for
emergency admission pursuant to section 3-600. The circuit court ultimately granted the
petition and, en route to that disposition, denied respondent’s motion to dismiss, wherein he
had argued, because he was never physically released pursuant to the court’s previous
discharge orders, his continued detention at the facility violated his rights under the Mental
Health Code and entitled him to a full and complete release. Andrew B., 237 Ill. 2d at 343-45.
¶ 47 The appellate court affirmed, rejecting respondent’s argument that the petition seeking his
involuntary admission was untimely filed under section 3-611 of the Mental Health Code. In re
Andrew B., 386 Ill. App. 3d 337 (2008).
¶ 48 We reached the same result. In upholding the order of the circuit court and rejecting
respondent’s contention that the emergency petition was untimely filed, we noted that “the
Code refers to ‘admission’ in a legal sense to describe the individual’s legal status” within a
facility. Andrew B., 237 Ill. 2d at 350. “In other words, section 3-611’s reference to
‘admission’ is not always limited to the individual’s original physical entry.” Id. Andrew
entered the facility on a voluntary basis, but while there, his legal status changed pursuant to
the filing and granting of an emergency petition for involuntary admission.
¶ 49 The takeaway, for our purposes, is that legal status may change while one is in a mental
health facility—and that could well be the case here. Respondent has not demonstrated that her
physical entry into the facility, and her initial treatment there, were involuntary. Thus, she has
not demonstrated that error occurred, that the petition for involuntary commitment was not
timely filed.
¶ 50 This court is not bound by the appellate court’s reasoning and may affirm on any basis
presented in the record. People v. Williams, 2016 IL 118375, ¶ 33. We apply that principle
here.
¶ 51 For the foregoing reasons, the judgment of the appellate court is affirmed.
¶ 52 Affirmed.
- 13 -